Over the last decade, there has been talk of an impending shortage of nurses. Even in light of the economic downturn, the soaring demand for more educated nurses is expected to continue as baby boomers age and health care coverage expands. For nurses who are entering or are in the field already, this demand presents an excellent opportunity to advance their careers and expand their knowledge.
So what is the logical next step? Often, it is to obtain an advanced degree. Once the decision to pursue higher education has been made, the next question is where to enroll. As online degree programs have increased in popularity over the last few years, many prospective students may wonder about the similarities and differences between online and traditional nursing programs. Before making your decision, consider what type of institution and program will best suit your needs and situation.
Benefits of an online education
Many nurses say the primary reason they chose an online program is because of the convenience and flexibility. Online learning offers students who are trying to balance a family, career, and other commitments the opportunity to earn a degree without sacrificing their other interests and obligations. An online nursing program may also offer a wider variety of degrees than a local university—if a local university is even an option. Especially in rural areas, the distance and time to travel to a brick-and-mortar institution may make this option impractical.
Another benefit of online learning is the asynchronous environment. In an asynchronous learning environment, students can participate at their convenience instead of being limited to participating at the designated location and the time when a class is offered. In the online format, students can generally post their homework and contribute to discussions when it works best for them. This is an especially important benefit to nurses who work shifts that potentially preclude them from attending traditional classes.
Some nurses believe that enrolling in an online program means losing out on the networking and interaction opportunities that occur in a traditional classroom. While it is true that actual face-to-face interaction is limited, nurses still have the opportunity to connect and network with other professionals online. The online setting also allows students to network with classmates and faculty from across the country and potentially around the world. As a result, nurses have the opportunity to hear about what’s happening beyond their local area, as well as benefit from the practical experience and knowledge shared by colleagues in other locations. The ability to connect with professionals from different practice settings and to share experiences and challenges is also cited as a unique feature of online learning. And other student resources, such as career advisement and even tech support, are typically as accessible and readily available via online universities as traditional.
While it may be the solution for some, online learning isn’t for everyone. There are students who want or need a traditional learning environment. For instance, an online classroom lacks the nonverbal cues that visual learners prefer. Some students simply need the face-to-face interaction. Many feel most comfortable having conversations in person and not over the phone or via an online discussion.
In addition, online and traditional nursing programs have different communication styles. On the job, nurses are taught to be succinct in their writing style because of the volume of required documentation in electronic records and because much of their work is done via checklists. Nurses who choose online education participate in a more intensive writing program than traditional education offers, since nearly all of the communication online occurs in written form. Prospective students should keep their personal communication style and preferred learning format in mind when selecting a program.
For both traditional and online nursing programs, practicum or clinical experience is required. However, practicum arrangements vary by degree program as well as by institution. Undergraduate practicums in face-to-face programs are usually arranged by the institution, while undergraduates in online programs typically propose the facility and preceptor. For graduate practicums, the trend for both online and face-to-face programs is for the student to propose their facility and preceptor.
No back row
Class participation is a very different dynamic in an online program versus a traditional program. In a traditional classroom, faculty members typically lecture, and grades are often based on exams and papers rather than on classroom participation. On the other hand, an online program places greater emphasis on participation: everyone participates in discussions by posting their thoughts—there is no back row.
The asynchronous online environment is an unexpected benefit for many students, because it allows students to think about what they want to say before they actually say it. Online students have time to reflect on the discussion, and they are actually more engaged. Traditional students who fear public speaking tend to stay silent in class, whereas an online setting can help build confidence in shy individuals or help those for whom English is a second language compose their thoughts before speaking.
Above all else, quality
Regardless of the delivery method, it is important that students find a quality nursing program. When researching which program or type of institution is best, one of the first things prospective students should check is the accreditation. The program should be accredited by either the National League for Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE). Additionally, the school should also have a Higher Learning Commission (HLC) accreditation if it offers doctoral programs, as Ph.D. programs are not NLNAC- or CCNE-accredited.
Another consideration when choosing a nursing program is to look at the level of faculty preparation and experience. Faculty credentials are important, and faculty members should be teaching in their areas of expertise—as established through both academic preparation and experience. Faculty members should be experts, and they should be certified in their areas of practice.
For an online nursing program in particular, it is important to see how long the institution has been in the business of teaching and offering classes online. Many schools are now offering classes online, but that doesn’t mean that their classes are designed for a truly online experience. To provide a high-quality online nursing program, it is necessary for the school to have expert instructional-design knowledge as well as the technology support that online students need.
Above all, prospective nursing students need to be diligent and research the institution. Talk to an enrollment advisor about the program and the various resources available. Also, reach out to faculty members and current students, as well as alumni who have gone through the program. Ask them questions about their experience, course content, and how the degree has helped them succeed. Prospective students can also check out benchmarks with the American Distance Education Consortium (ADEC), the American Federation of Teachers (AFT), and the National Education Association (NEA) to see if the institution they are interested in enrolling in is meeting those benchmarks.
At the end of the day, there is no significant difference between student outcomes for traditional and online nursing programs. Both can provide a rewarding learning experience, but, ultimately, it is up to the student to determine which program and delivery method are best suited to his or her current situation and needs.
With over 2,000 nursing schools in the United States, it can be challenging to determine which nursing program will meet your specific needs. In addition to traditional nursing programs that meet on campus, there has been a significant increase in the number of accelerated and online nursing programs being offered across the country.
The American Association of Colleges of Nursing (AACN) says accelerated programs for non-nursing graduates have gained momentum as colleges work to meet the Institute of Medicine’s call to increase the proportion of nurses with baccalaureate degrees to 80% by 2020. According to AACN statistics, research has shown that lower mortality rates, fewer medication errors, and positive outcomes are all linked to nurses prepared at the baccalaureate and graduate degree levels.
“I believe the BSN should be the minimum requirement for entry to practice for all nurses,” says Monica McLemore, PhD, MPH, RN, an assistant professor of family health care nursing at the University of California, San Francisco. “Science moves too quickly for nurses not to have a broad set of skills that are included in the four-year degree. I also believe nurses need to advance their education and to plan for this advancement in the context of the rest of their lives.”
Choosing an Accelerated or Online Nursing Program
The Saint Louis University School of Nursing introduced the first accelerated BSN program in the country, says Teri A. Murray, PhD, APHN-BC, RN, FAAN, dean of the school of nursing. The 12-month program was launched in 1971 for students with a non-nursing bachelor’s degree who were interested in pursuing an RN license and a BSN degree. The university also offers a 21-month accelerated MSN program.
For those with a prior degree, accelerated nursing programs offer the fastest path to becoming a registered nurse with programs generally running 12 to 18 months long. The Saint Louis University RN-to-BSN program can be completed in three full semesters and also offers clinical experiences at top hospitals and a simulation laboratory.
“We need more baccalaureate-prepared nurses from diverse backgrounds,” says Murray. “The United States Department of Health and Human Services says there are approximately three million RNs living in the U.S. Of those, 16.8% identified as belonging to a racial and/or ethnic minority, which remains far removed from the 28% diversity of the general population.”
For registered nurses who are looking to earn their bachelor’s degrees, many colleges have begun offering RN-to-BSN programs. Oregon Health and Science University (OHSU) in Portland, Oregon, is one such college that offers an online RN-to-BSN program.
“Our online BS-RN program focuses on leadership, population-based community care, and evidence-based practice,” says Glenise McKenzie, PhD, RN, an associate professor and the RN-to-BSN program director at the OHSU School of Nursing. “In our Leadership courses, students learn how to analyze systems-level data and improve health care delivery through the development of a quality and/or process change project. In Population-Based Health, students focus on community and public health nursing, incorporating social, environmental, and cultural assessments into the care of a selected population in a non-acute care setting.”
McKenzie says the OHSU online program utilizes a variety of teaching and learning strategies throughout courses, including: voice-to-voice webinars; voice-over lectures; small online asynchronous and synchronous group discussions; online group projects and presentations; one in-person conference (two days with public health and community assessment focus, including a simulated cultural diversity experience); individual written assignments; online quizzes; and guided learning activities focused on application of health and wellness concepts.
Kamala Basak, RN, who works as nurse manager at the Tri-City Health Clinic in Fremont, California, is currently enrolled in an online RN-to-BSN program through Grand Canyon University in Phoenix, Arizona.
“In the RN-to-BSN program, I’ve learned how to lead a team instead of just managing my staff,” says Basak. “In addition, being able to study and research on my own helps me learn the material in a better way—and that is why I prefer learning online. In this program, even though we do not see our classmates, we still communicate and work together to complete our group projects.”
Going Beyond the Bachelor’s Degree
Elizabeth Florez, PhD, RN, assistant professor at the DePaul University School of Nursing in Chicago, Illinois, strongly encourages aspiring nurses not only to obtain their BSN, but also to continue on to get an advanced degree. Nurses with a graduate education provide direct patient care at an advanced level, conduct research, teach, impact public policy, lead health systems, and more.
“Many hospitals will now only hire BSN-prepared nurses or require diploma nurses already working in the hospital setting to go back to school to obtain a BSN,” Florez says.
Florez notes that aspiring nurses who already have a non-nursing bachelor’s degree can also apply to a generalist in nursing master’s program where they will obtain a master’s degree and they will be able to sit for the National Council Licensure Examination (NCLEX) board exam.
“Obtaining a master’s degree in nursing offers many additional benefits for advancement once the nurse has sufficient nursing experience,” Florez says.
And it’s never too late to go back to school to obtain an advanced nursing degree. McLemore went to nursing school right out of high school at the age of 17, but completed her PhD program at the age of 40.
“I wish I had entered graduate school sooner than I did [six years after completing my BSN],” she says. “I plan a long research, teaching, and clinical career.”
Murray also completed her doctorate program just as she was approaching her 40th birthday.
“Had I known the benefits of doctoral education, I would have started immediately after completing my BSN,” Murray says. “This would have given me a longer time to make strong contributions to advancing the field of nursing. Nursing is a wonderful field, and there are many expanded opportunities that come with graduate education at the MSN, DNP, or PhD level.”
Florez says there is a great need for more nursing professors overall, but especially nursing professors from minority backgrounds.
“Master’s degree students are encouraged to seek clinical instructor positions once they obtain sufficient nursing experience, and they are also encouraged to continue their advanced education to the doctorate in nursing practice or PhD level to obtain a faculty position,” says Florez. “Currently, DePaul University has a Bridges to PhD program, which is a National Institutes of Health funded grant program affiliated with the University of Illinois at Chicago. That program is meant to increase the number of minority faculty with a PhD.”
Eligible DePaul nursing students enrolled in the master’s entry to nursing practice program are able to apply to the Bridges to PhD program, and qualified students will then be provided many resources and support to ensure they are adequately prepared for the PhD program.
Making Nursing School Affordable
While the cost of an education can be a barrier for many nurses, experts say there are many scholarships and financial incentives available that can help to make nursing school more affordable.
Students should never assume they can’t afford a specific nursing school, says Aara Amidi-Nouri, PhD, RN, associate professor, chair of the BSN program, and director of diversity at Samuel Merritt University School of Nursing in Oakland, California.
“I see far too many high school students who incorrectly assume they can’t attend private nursing schools, when they could easily qualify for financial aid,” says Amidi-Nouri. “My recommendation is for students to widen the net and examine their options before committing to a particular program.”
And although the Free Application for Federal Student Aid (FAFSA) is available January 1, many students don’t apply until the last minute. This doesn’t give them enough time to complete the process, and can also prevent them from obtaining certain grants and scholarships offered on a first-come, first-served basis. Other students don’t know financial aid is an option, or believe they won’t qualify because of their income.
“Students should always apply for FAFSA to receive financial aid but also look into scholarship opportunities,” says Florez. “Some colleges or universities may offer internal scholarships; however, students should also be encouraged to seek outside scholarships, such as through minority nursing associations, professional nursing organizations, and state/national scholarship programs.”
In addition, Florez notes that many nursing organizations will allow students to become student members, thus offering them additional mentorship and financial support.
“There is even more financial assistance available for minority students seeking a PhD in nursing through grants, fellowships, and teaching/research assistant positions,” says Florez. “Once students complete their nursing program and begin working in the field, they may qualify for loan repayment programs such as the one offered through the Health Resources and Services Administration that pay back a portion of nursing loan debt for registered nurses working in hospitals and clinics that care for underserved, underinsured, and uninsured populations.”
Many nursing schools, including the St. Louis University School of Nursing, are making a concentrated effort to attract more minority and male nursing students.
“For the past six years, we’ve been the proud recipient of the Robert Wood Johnson Foundation New Careers in Nursing Scholarship,” Murray says. “This scholarship program is directed toward underrepresented students, which include males and minorities, for entry into the accelerated program in an effort to diversify the nursing profession.”
What to Look For in a Nursing School
Amidi-Nouri says choosing a nursing school depends a lot on a student’s goals and where they are in the process. A high school student may choose a different program than a paraprofessional (CNA, LVN) who is already working in the field.
“If you’re looking at an RN program, such as an ADN, check to see if the school has a joint program with a BSN program, or whether you will have to reapply to an RN-BSN program to obtain your BSN,” suggests Amidi-Nouri.
Amidi-Nouri encourages prospective students to consider the following when choosing a nursing program:
• What is the nursing school’s graduation rate?
• What is the NCLEX pass rate?
• What is the local reputation of the school?
• What commitment does the school make to diversity (e.g., mission statement, vision statement, course offerings, diversity office)?
• What are the values of the school of nursing and of the university?
• What kind of academic support is available? Tutoring? Mentoring?
• How long is the program and what are the different pathways to get there?
• Are the faculty bios on the website? Do you see that faculty are diverse and/or have interest in diversity and health disparities?
• Is there a part-time option? If so, how long will that take?
• Are there information sessions, either live or virtual, that can tell you more about the program?
“Technology is important and students should seek programs that have vast resources in terms of a skills lab,” says Mona Clayton, RN, BSN, an author and nurse from Lakewood, California, who completed nursing school as a single mother, and now encourages other single mothers to enter the nursing profession in her “Surviving the Journey” seminars. “Finding schools that are associated with “magnet” hospitals, accredited by the American Nurses Credentialing Center, is a plus.”
Magnet hospitals are recognized for having better nursing environments, promoting excellence in nursing practice, and providing high quality patient care.
“Use the Board of Registered Nursing website as a resource for finding schools with top-notch passage rates for the National Council Licensure Examination (NCLEX-RN) exams,” Clayton says. “I also encourage single parents and working students to seek out programs that are flexible and offer weekend and evening classes.”
Murray advises minority students to also seek institutions with a welcoming campus atmosphere and a mix of diverse individuals (e.g., faculty, students, and staff).
“Often when there are only a handful of diverse individuals, students voice concerns related to feelings of isolation, alienation, and loneliness,” Murray says. “The student should determine if the institution’s leadership supports a diverse and inclusive climate evidenced by proactive actions, policies, and services that support this belief.”
Students should also ensure the nursing school they choose to attend is accredited by the Commission on Collegiate Nursing Education or the National League for Nursing Accrediting Commission.
“Accreditation is important for making sure the nursing school has met the state requirements to be able to take the national board exam,” Murray says. “Minority students should select a nursing program that has additional support for students to be successful. The additional support might be in the form of a nursing student organization, mentor/mentee program, tutoring, open lab hours, success coaches, et cetera.”
Melissa Leung, RN, BSN, still remembers the day she encountered an elderly patient who was resisting her medication. The woman, a native of China, had balked when given her pills and a glass of cold water, and it was noted on her chart that she was “medically noncompliant.” Leung, who is fluent in Mandarin, gently spoke to the woman in her native language to determine why she was reluctant to take her medicine.
“Like many Chinese immigrants, she had been taught to drink hot water with meals,” says Leung, who works in the cardiac catheterization lab at Einstein Medical Center in Philadelphia. “In China, some people are taught to boil water before drinking it to remove germs, and others believe that drinking cold water is bad for the stomach.”
Leung noted on her patient’s chart that she preferred to take her medications with hot water. As a bilingual nurse, Leung was able not only to communicate with her patient in her native language, but also to provide culturally specific care by being sensitive and responsive to her patient’s cultural beliefs and traditions.
As immigration increases, the demand for bilingual and multilingual nurses continues to grow. According to the US Census, between 1980 and 2010, the number of people speaking a language other than English climbed 158%. In addition to English and Spanish, the 2011 Census showed there were six languages spoken at home by at least 1 million people: Chinese (2.9 million); Tagalog (1.6 million); Vietnamese (1.4 million); French (1.3 million); German (1.1 million); and Korean (1.1 million).
Hospitals across the country are seeing more patients with different language needs, cultural sensitivities, and religions. While interpreters are employed by many hospitals, bilingual and multilingual nurses provide another way of bridging the cultural gap.
Because factors such as language, unfamiliar customs, and misconceptions about health care can keep foreign residents from seeking medical care, bilingual nurses can help to ease a patient’s fears and even reduce barriers to clinical preventative care.
There are also professional benefits to learning another language: Some bilingual employees can earn more than their single-language colleagues.
Providing Culturally Sensitive Care
Jimmy Andres Reyes, RN, MSN, DNP, AGNP, of Cedar Rapids, Iowa, an instructor in advanced practice nursing with Kaplan University School of Nursing and the dean of nursing at Kirkwood Community College, says he was inspired to become a nurse after watching the work of his grandmother, who was a community health nurse in Santiago, Chile.
Five years ago, Reyes received a predoctoral scholarship award to study diabetes self-management in Latino older adults. Fluent in both Spanish and English, Reyes says that being bilingual allowed him to hold focus groups in Spanish that helped staff determine the stressors and barriers that prevented the patients from keeping their diabetes under control.
“We learned many of these older adults would simply nod and agree with their health care providers, even if they didn’t understand the instructions they were being given,” explains Reyes. “For them, it was simply easier to be cordial, but as a result, they weren’t learning the tools and information needed to manage their diabetes.”
Reyes and his colleagues were able to take the information gleaned in talking with Latino immigrants and to pilot several programs. The information they gathered was not only translated into Spanish, but also designed to be culturally sensitive and relevant.
Reyes also believes that nurses can learn about different cultures through medical missions and studying abroad. He recently accompanied a group of nursing students to Costa Rica and plans to take another group to Ecuador later this year.
“Traveling to Costa Rica changed the world view of all of our students, and even those who didn’t speak Spanish returned to the US with a better understanding of the health care barriers and challenges that many immigrants face,” says Reyes.
As a bilingual nurse educator, Reyes believes his job in providing culturally sensitive care isn’t to change the beliefs of his patients, but rather to provide them with all of the facts they need to manage their condition.
“We have recently started working on a cancer prevention project with Latino and Burmese immigrants,” he explains. “Most of the people we spoke with weren’t aware of the new HPV vaccine that can be given to teens to protect them against the virus that causes cervical cancer and some other forms of cancer. We’re not mandating they vaccinate their kids, but rather providing them with the information to make an informed decision.”
Reyes is a member of several professional organizations, including the National League for Nursing, the American Academy of Nurse Practitioners, the Gamma Chapter of Sigma Theta Tau International, and the National Association of Hispanic Nurses, to name a few. He encourages nurses to become involved in organizations and associations that can give them a better understanding of the diverse patients they serve, as well as to consider learning a second language to better communicate with their patient population.
“We have nurses who are not Latino or Burmese who have picked up on the languages, and the patients just beam when they hear the nurse interacting with them in their native language,” says Reyes. “It not only shows they care; it’s also the first step in building trust.”
Addressing Patients’ Unique Cultural Beliefs and Concerns
Shency Varughese, MSN, RN, an immigrant nurse from India, works in the Inpatient Surgical Unit at the Cancer Treatment Centers of America, Midwestern Regional Medical Center, in Zion, Illinois. She has found that speaking a familiar language with patients helps earn their trust and respect.
“According to the nurse theorist Dr. Madeleine Leininger, nursing care must be customized to fit with the patient’s own cultural values, beliefs, traditions, practices, and lifestyle,” says Varughese. “I was able to put this into practice recently while caring for a patient who had a special request for a specific Indian tea that contained natural immunizers such as ginger and cardamom.”
Varughese notes the tea needed to be prepared in a special way and was very important to the patient. Although she acknowledges the act of preparing tea wasn’t earth shattering and could have been performed even with a language barrier, the act allowed her the chance to connect with the patient and provide culturally sensitive care.
“Our shared Hindi language allowed me to truly listen and understand his request and respect his needs,” explains Varughese. “I was able to understand how the preparation and drinking of the tea was an important part of this patient’s life.”
Varughese says being multilingual has also helped in her nursing career: “My peers know that they can count on me if a patient has a need or request. We have a translation service that our patients use to help communicate anything related to their medical needs; however, I am more than happy to step in and help with all non-medical patient requests.”
Nenette Ebalo, RN, has found that her ability to speak Tagalog provides an extra layer of comfort to the Filipino patients she sees in her job as service unit manager for the Head and Neck Surgery department at Kaiser Permanente’s Oakland Medical Center. In addition, Ebalo notes that in-person communication allows her to take cues from a patient’s body language that may be lost over the phone. It also allows for easier communication with elderly patients who may be hard of hearing.
“As a bilingual nurse, I don’t replace our medical center’s interpreting staff, but I am able to help patients who might prefer an in-person interaction with a nurse,” says Ebalo. “This can be helpful, especially for those who have complex medical conditions and may not understand the medical terminology.”
Ebalo remembers a recent case when she encountered an older couple waiting to see a speech pathologist. The wife told Ebalo she was concerned because her husband was suddenly having speech problems, and after speaking with Ebalo in Tagalog, they asked if she could accompany them to their appointment. After a consultation with the speech pathologist, Ebalo was able to explain to the wife that her husband’s condition was a side effect of the radiation he had been given.
“They were very appreciative of my help and returned later that week with Ensaymada, a traditional Filipino sweet bread to thank me,” says Ebalo.
In addition to her work at the hospital, Ebalo has worked on several medical missions and has found that her language skills prove beneficial when caring for patients abroad.
“I recently accompanied some of our physicians on a medical mission to the Philippines where I worked as a bedside nurse in the recovery room,” says Ebalo. “The doctors were repairing cleft lips and palates, and they relied on me to help them to understand both the language and the culture.”
Breaking Communication Barriers
Michelle Moore, BSN, RN, HN-BC, inpatient care manager at the Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, Illinois, first learned American Sign Language (ASL) to communicate with her daughter who was born deaf. Since then, Moore has found that knowing ASL has also helped her in her job.
“Deaf individuals are unique in that they cannot use a language line to talk with the hearing community,” says Moore. “Deaf people use electronic devices—mostly smartphones now—to communicate with the hearing world. Years ago, I was part of the committee that helped bring devices [such as TTY, the flashing door bell, and the bed alarm] to the hospital.”
In addition, Moore says that although she is not a certified ASL interpreter, she has had general conversations with deaf patients and their caregivers, which allows them to feel comfortable with a culture they are familiar with.
“Having the ability to speak with people in their common language is such a gift,” says Moore. “Years ago, we had a new patient who was deaf, and her interpreter was running late. I remember sitting in the lobby waiting with the patient and just carrying on a normal conversation with her. The patient felt comfortable that someone in a strange environment was available and familiar with her language.”
Moore notes that every time the patient would return to the hospital, she would ask to see her. “She often shared with me how grateful she was that I was with her on her very first visit and how it allowed her fear to decrease and put her mind at ease,” says Moore.
Becoming a Certified Medical Interpreter
While many bilingual nurses help patients in an unofficial capacity, some nurses are taking their translating skills to the next level and becoming certified medical interpreters. Having credentials provides documentation that nurses have the necessary skills required to translate or interpret professionally.
Yelena Tuerk, RN, BSN, MS, manager, patient care services, for the Rose D. and Joseph W. Lazinsky Neuroscience Center at Sinai Hospital in Baltimore, was born in Russia and is fluent in both Russian and English. After seeing a large influx of Russian patients at her medical center, Tuerk decided to become a certified medical interpreter in order to assist patients in a more official capacity.
Tuerk enrolled in the three-day Qualified Bilingual Staff program offered through the Maryland Healthcare Education Institute, which covered many areas including legal requirements, cultural competency, and privacy laws.
“The course taught the specific way to translate for nurses to ensure that we provide high quality care,” explains Tuerk. “The training goes beyond just speaking a second language; it also covers how to best convey medical terminology, and how to serve as the voice of the patient to ensure that all of their questions are addressed.”